RESUMEN

Objectives: The Road to Health Chart (RTHC) provides a simple; cheap; practical and convenient method of monitoring child health. The RTHC could assist with vaccine compliance and early identification of growth faltering; to improve general health. The purpose of the study was to assess whether the RTHCs were adequately completed and interpreted at primary; secondary and tertiary care levels in South Africa.Methods: The study was carried out at a primary; secondary and tertiary care centre. A questionnaire was administered to 100 subjects from each; seeking demographic information; whether the RTHC was brought along; and if not why it was not brought.Results: Most children were brought by their mothers. The RTHC was not brought to 48 of the consultations; of those; about 72 thought that bringing the RTHC along was not necessary. Health workers seldom asked to see the RTHC at the primary and secondary care settings; but 50 of them did so at Ga-Rankuwa Hospital (p = 0;002). In only 8 cases overall were the children below the 3rd percentile of weight-for-age. Approximately 20 had incomplete immunisations.Conclusions: Many parents believe that the RTHC is only required for Well-baby-clinic visits; not for consultations. The RTHC is not often asked for at consultations; the fact that this is more often done at the tertiary care centre may be that much of the service is supplied by paediatricians-in-training. Health workers should ask to see the RTHC; in order for mothers to understand the importance of the information. The study showed that the RTHC is not used to its full potential

Asunto(s)

Asunto(s)

Asunto(s)

Asunto(s)

RESUMEN

Rotavirus is an ubiquitous virus associated with severe gastro-enteritis in children under 2 years of age. However, serious conditions, including central nervous system involvement, have been associated with rotavirus infection. We investigated the clinical signs and symptoms of rotavirus infection in 156 neonates, specifically focusing on neurological signs. Neurological signs identified were apnoea, jitteriness, convulsions and poor sucking. Of the 156 babies, 66 were rotavirus-positive and 90 rotavirus-negative. In the rotavirus-positive group, 19.7% manifested apnoea compared with 22.2% in the rotavirus-negative group. The other three symptoms occurred in <10% of the neonates. Rotavirus dsRNA was detected by RT-PCR in the CSF of two. One had apnoea, the other no CNS symptoms. Although rotavirus infection in neonates is hardly ever asymptomatic and may cause death, it has not been associated with CNS symptomatology in our studies.

Asunto(s)

RESUMEN

OBJECTIVE: In South Africa, rapid urbanisation has increased the risk of childhood asthma. This report reviews the pattern of asthma admissions to the Paediatric Department of Ga-Rankuwa Hospital, South Africa, from 1986 to 1996. DESIGN: Inpatient admission data were reviewed for 1986-1996. A detailed analysis of the records of asthma patients admitted between 1992 and 1996 was done. Outpatient data were reviewed from 1992. SETTING: Ga-Rankuwa Hospital, situated on the border of the Gauteng and North West provinces of South Africa and serving a large black population in various stages of urbanisation. MAIN OUTCOME MEASURES: Trends in admission numbers and demographic characteristics. RESULTS: Asthma admissions were 2.5 times higher in 1996 than 1986. The greatest increase in admissions was in the 1-47-month age group. The male to female ratio was 1.5:1. More patients came from urban than from rural areas. Admissions peaked during the summer. Re-admissions occurred most frequently within 3 months of the first admission. CONCLUSION: Paediatric asthma admissions have shown an increase in the past decade. This may be associated with changes in the environment of the community. There is a need for preventive programmes for asthma at community and national level.

Asunto(s)

RESUMEN

In South Africa there has been an unenthusiastic response to oral rehydration therapy. Parents and patients still demand hospital therapy for gastro-enteritis, even in cases that can be successfully managed at home using oral rehydration solution (ORS). The aims of this study were to assess whether a period of contact with health workers (doctors, nurses and medical students) had an effect on the carers' knowledge of gastro-enteritis. Fifty carers of children aged 2 years and less with gastro-enteritis were interviewed on admission and on discharge from the paediatric short-stay facility. Eighty-eight per cent of the babies had had acute gastro-enteritis (for less than 7 days). According to the carers (44% on admission and 52% on discharge), teething was the commonest cause of gastro-enteritis. On discharge, 50% of carers did not know any of the signs and symptoms of dehydration. Sixty-seven per cent of carers had first tried ORS at home, but of these only 49% could prepare an acceptable solution. Clinics are the commonest source of information about ORS (according to 78% of carers). All the carers said they had received no health education in the hospital. On discharge only one career knew that she had been given a follow-up date and why she had to bring the child for follow-up. Contact with health workers during a period of admission to the paediatric short-stay facility had no impact on caretakers' knowledge of gastro-enteritis and its management.

Asunto(s)

RESUMEN

AIM OF STUDY: Non-compliance is an important factor hindering good control in diabetics. The aim of this study was to identify areas of poor compliance with the diabetes management regimen in the children attending our clinic. DESIGN: A questionnaire was administered to 57 patients who attend the Paediatric Diabetes Clinic. It was designed to elicit socio-demographic data and information about the diabetic regimen. Prior to the administration of the questionnaire, patients were classified as being well, satisfactorily or poorly controlled, based on their average glycosylated Haemoglobin results over the past year. RESULTS: All the patients used home blood glucose monitoring (HBGM)-79% of the poorly controlled children tested twice daily or less whereas 53% of the well controlled children tested three times or more daily. The timing of injections was frequently incorrect. 42% of all patients had been admitted to hospital after diagnosis and more than 60% of them never tested their blood glucose in relation to exercise. The patients' knowledge about their disease was generally good. The mean age of the poorly controlled group was almost 19 months older than that of the well controlled group. Poorly controlled children had also had diabetes for longer and they lived significantly further from the hospital. A higher percentage of poorly controlled patients were in charge of their own treatment while those in the well controlled group were less reliant on doctors for insulin dose adjustments.

Asunto(s)

RESUMEN

Fungal septicaemia has become a frequent problem in neonatal intensive care units. The usual treatment for this condition, amphotericin B alone or in combination with 5-fluorocytosine, is sometimes unsatisfactory, especially in neonates. We report our experience of fluconazole in neonates. Neonates who developed Candida septicaemia in the neonatal unit of Ga-Rankuwa Hospital (MEDUNSA) over a 1-year period were treated with oral fluconazole. The diagnosis was based on fungal cultures obtained from sites which are normally sterile. Blood cultures and renal, haematological and liver functions were monitored regularly. Therapy was continued for at least 1 week after the first negative culture was obtained. Twenty-one neonates were treated; the clinical and microbiological cure rate was 90.5%. No serious renal, haematological or hepatic complications were detected; mild hepatotoxicity was evidenced by elevated enzymes in a third of the children. Relapse occurred in one baby who received inadequate doses of fluconazole. Two babies died of causes unrelated to a systemic fungal infection. We conclude that fluconazole may be a safe and effective alternative for the management of systemic candidiasis in neonates. A comparative trial is necessary.

Asunto(s)

RESUMEN

OBJECTIVE: Fungal septicemia is a devastating disease in the neonate, especially in the low birth weight preterm infant who is especially vulnerable to disseminated fungal sepsis. The objective of this study was to compare the efficacy, safety and overall convenience of fluconazole vs. amphotericin B for the treatment of disseminated fungal sepsis in neonates. DESIGN: A prospective, randomized, collaborative study conducted at two South African neonatal units. SUBJECTS: Twenty-four infants with proven fungal septicemia were treated from June, 1992, to June, 1993. Twelve received fluconazole, 11 received amphotericin B and 1 was excluded. Assessment of hepatic, renal and hematologic functions were performed before, during and after treatment. The two groups were comparable at the time of enrollment into the study. RESULTS: Infants receiving amphotericin B had significantly higher values of total and direct bilirubin and alkaline phosphatase values at the end of treatment, while the fluconazole group showed a significant increase in the platelet count. The cumulative total numbers of days receiving intravenous therapy for the administration of antifungal drugs were 57 for the fluconazole group and 162 for the amphotericin group; no central lines were needed in the fluconazole group, whereas 3 babies given amphotericin B had central catheters for a cumulative total of 27 days. The case fatality rate was 33% in the fluconazole group and 45% in the amphotericin B group; there was still proof of fungal septicemia at the time of death in 1 patient given amphotericin B and 2 given fluconazole. CONCLUSION: Fluconazole showed fewer side effects than amphotericin B and was more convenient to use.

Asunto(s)

RESUMEN

OBJECTIVE: To examine the patient profile encountered in the first year of operation of the Child Abuse and Neglect Clinic of the Transvaal Memorial Institute. DESIGN: Record review of all cases presenting to the Clinic from May 1988 to April 1989. RESULTS: Females comprised just over 80% of the 227 patients. Sexual abuse was the presenting complaint in 89.8%. Most were young, 7% under 3 and 55% under 10 years of age. Almost one-third of the boys and 5.0% of the girls had chronic signs of anal abuse. Of the girls 56% had signs of chronic and 10% signs of acute vaginal abuse. Where the certainty of sexual abuse was high, 60% of the girls and 45% of the boys had suffered penetrative abuse. The perpetrators were almost invariably known to the child; biological family members accounted for 38% of perpetrators, and if all relations are included (biological, step and 'common law'), family members were the perpetrators in 66% of cases. Strangers were the perpetrators in only 7% of our cases. The majority of perpetrators were male. Behaviour problems were recorded in 73% of cases. Many different problems were noted; the most common were school problems (21%), masturbation (19%), 'clingy' behaviour (12%), and withdrawal and depression (11.5%). CONCLUSIONS: Certainty of diagnosis should be specified. We use four categories: proven, highly suspected, unproven but still suspected, and no abuse. For sexual abuse we also differentiate between penetrative, non-penetrative, 'type uncertain' and no abuse. Training of other health personnel in child abuse management is now a priority in our setting.

Asunto(s)

RESUMEN

During diarrhoeal disease, stool mass is usually increased. Lactose content of stools and stool pH have been used as tests for secondary lactose maldigestion. The effect of a lactose-free diet and various lactose loads on the stools of 30 children with primary adult-type lactose maldigestion was investigated. Stool mass following the lactose tolerance test was the largest (mean = 80 g/day); that following the milk tolerance test less--62 g (not significantly), that on a milk containing diet significantly less (35 g), while stool mass produced on a lactose-free diet (22 g) was significantly less than that produced on any of the three lactose-containing diets. The stool pH on a milk containing diet (mean = 6.3) was significantly higher than those of the three other diets (after lactose tolerance test, pH = 5.85; after milk tolerance test, pH = 5.86; after lactose-free diet, pH = 5.83). Although stool bulk was greater when these lactose maldigesters were consuming a lactose containing diet, it was still considerably less than the stool mass associated with secondary lactose maldigestion, which is believed to be a cause of diarrhoeal disease. In contrast, the primary adult-type of lactose maldigestion does not commonly cause diarrhoea, as shown in this study.

Asunto(s)

Asunto(s)

Asunto(s)

RESUMEN

Doctors who have to give evidence in cases of physical or sexual child abuse usually find it a stressful experience. Factors that may help to improve the doctor's ability to cope with the situation are discussed in this article. The importance of good medical notes and a good medical examination is stressed. Hints are given on how to minimise the inevitable delays that precede a court appearance. The hearsay rule means that the history the doctor obtains is not accepted as evidence. The medical procedure, which involves using various facts to build up a complete picture, is contrasted with the legal procedure, which involves testing each separate fact in order to create reasonable doubt that the accused may be guilty. Some common questions put to the doctor are discussed here. They include questions as to whether causes other than abuse, such as masturbation, infection or the use of other instruments, could have damaged the hymen or vagina.

Asunto(s)

RESUMEN

The sexually transmitted disease surveillance system instituted at the Child Abuse and Neglect (CAN) clinic of the Transvaal Memorial Institute for Child Health and Development was evaluated after 1 year. The presenting complaint of the vast majority of the 227 patients was sexual abuse. In more than half (52%), child abuse was medically proven, and it was highly suspected in another 18%. In only 6% did no abuse take place. About half the patients suffered non-penetrative sexual abuse, 40% penetrative abuse and 10% suffered non-sexual abuse. Smears for gonorrhoea were positive in 2 out of 152 patients; for Chlamydia in 1 out of 140; for Gardnerella and Trichomonas in 2 and 1 case, respectively. Syphilis serology yielded 3 positive results out of 162, and hepatitis B, 6 out of 143. No positive results were found in tests for HIV and herpes. With the exception of hepatitis B tests, all positive results occurred in children considered on clinical grounds to have medically proven or highly suspected sexual abuse. These results will allow modification of the surveillance system and testing of those children more likely to test positive, while doing fewer tests overall.

Asunto(s)

RESUMEN

Medicine is fraught with controversies, and several strategies have been developed in order to reach rational conclusions. Examples are using more subjects or an improved research design, developing consensus statements or using meta-analysis. An additional strategy is described in this paper. The language content of scientific papers is examined to establish whether the authors use factual (informational) language or emotional appeals (directive language) to convince the reader. This type of content analysis is then applied to a sample controversy. The paper shows that directive language content analysis can be applied effectively to scientific publications to clarify the basis of and reasoning behind some controversies.

Asunto(s)

Asunto(s)

Asunto(s)

Asunto(s)